Correlates of Motivation to Change in Pathological Gamblers Completing Cognitive-Behavioral Group Therapy

A Psychometric Analysis of the Patterns of Adapted Learning Scales (PALS) with a Group Psychotherapy Patient Sample: A Measure of Motivation

Previous research has examined the role of clients' goal orientation, or the motives one uses to achieve specific tasks or goals in individual therapy highlighting the importance of clients' goal orientation within a therapeutic context. Constructing and validating a measure of clients' achievement goal orientation in group psychotherapy is needed to allow for additional methodologically sound research to examine the role of achievement goal orientation in the process and outcome of group psychotherapy. Data from 99 adult group members across 23 interpersonal process groups were used to investigate the psychometric properties of the Patterns of Adapted Learning Scales-Group Psychotherapy Version (PALS-GP), including internal reliability, structural validity, and concurrent and criterion-related validity. The PALS-GP scores revealed an overall good internal consistency (α = .76-.86) and yielded a robust three-factor structure. Evidence of concurrent and predictive validity was also demonstrated with a measure of group alliance and client improvement, respectively. The PALS-GP appears to be a promising instrument for measuring goal orientation with a clinical population participating in group therapy.

Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.

Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).

Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p<0.001, respectively).

Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.

Suicidal behavior in patients with gambling disorder and their response to psychological treatment: The roles of gender and gambling preference

Suicidal ideation and attempts are prevalent among patients with gambling disorder (GD). However, patients with GD and a history of lifetime suicidal events are not a homogeneous group. The main objective of this study was to compare sociodemographic, clinical, personality, and psychopathological features among different profiles of adults with GD with and without a history of suicidal behavior, taking into account two relevant variables: gender and gambling preference. The second aim was to examine how the different profiles of patients with a history of suicidal events responded to cognitive-behavioral therapy (CBT). A total of 1112 treatment-seeking adults who met the criteria for GD were assessed at a hospital specialized unit for the treatment of behavioral addictions. The participants completed self-reported questionnaires to explore GD, personality traits, and psychopathological symptomatology. The lifetime histories of suicidal ideation and attempts, and gambling preferences, were assessed during semi-structured face-to-face clinical interviews. Of the total sample, 229 patients (26.6%) reported suicidal ideation and 74 patients (6.7%), suicide attempts. The likelihood of presenting suicidal ideation was higher for women than men, but no differences were observed based on gambling preference. Regarding suicide attempts, the odds were higher among women with non-strategic forms of gambling. Suicidal ideation and attempts were associated with higher GD severity, a worse psychopathological state and higher self-transcendence levels. In terms of treatment outcomes, neither gambling preference nor past suicidal behavior had an influence on dropouts and relapses. Nevertheless, female gender and a lack of family support constitute two good predictors of a worse treatment outcome.

Lohnt es sich an meiner Sucht zu arbeiten?

Fragestellung Ein vorzeitiger Behandlungsabbruch stellt eines der häufigsten Probleme in der stationären Entgiftungsbehandlung dar. Die vorliegende Studie ist der Frage nach der Rolle motivationaler Faktoren nachgegangen.

Methode Es wurden 85 PatientInnen neben den routinemäßig erhobenen Befunddaten, zum Zeitpunkt der Aufnahme als auch der Entlassung verschiedene Fragebögen zur Symptomschwere psychischer Störungen, Funktionsbeeinträchtigungen sowie Veränderungsmotivation vorgelegt.

Ergebnisse PatientInnen, die die Behandlung abgeschlossen haben, gaben eine signifikant höhere Veränderungsmotivation an, als PatientInnen, die die Behandlung vorzeitig abgebrochen haben. Dabei hatte die Contemplations-Phase einen prädiktiven Wert (OR: 3,472) auf einen Behandlungsabbruch. Eine erfolgreich absolvierte Behandlung reduziert signifikant die Symptomschwere psychischer Störungen sowie Funktionsbeeinträchtigungen. Auf der Ebene der Veränderungsmotivation zeichnet sich ein signifikanter Zuwachs.

Schlussfolgerung Neben den bekannten Risiken für einen Abbruch scheint die messbare Veränderungsmotivation zu Beginn der Behandlung einen möglichen Marker für den Behandlungsverlauf darzustellen. Implikationen für die klinische Praxis werden abgeleitet.

Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers

BACKGROUND AND AIMS

The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory.

METHODS

The sample included n = 192 patients, aged 19-35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis.

RESULTS

Three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness.

DISCUSSION AND CONCLUSIONS

Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy.

Developmental trajectories of gambling severity after cognitive-behavioral therapy

AIMS

To estimate trajectories of the gambling disorder (GD) severity for 12 months following a manualized cognitive-behavior-therapy (CBT) program, and to identify the main variables associated with each trajectory.

METHODS

Latent Class Growth Analysis examined the longitudinal changes of n = 603 treatment-seeking patients with GD.

RESULTS

Five separate empirical trajectories were identified: T1 (n = 383, 63.5%) was characterized by the most highest baseline gambling severity levels and positive progress to recovery during the follow-up period; T2 (n = 154, 25.5%) featured participants with high baseline gambling severity and good progress to recovery; T3 (n = 30, 5.0%) was made up of patients with high gambling baseline severity and slow progress to recovery; T4 (n = 13, 2.2%) and T5 (n = 23, 3.8%) contained participants with high baseline gambling severity and moderate (T4) and poor (T5) progress in GD severity during the follow-up. Psychopathological state and personality traits discriminated between trajectories. Poor compliance with the therapy guidelines and the presence of relapses also differed between the trajectories.

CONCLUSIONS

Our findings show that patients seeking treatment for GD are heterogeneous and that trends in progress following treatment can be identified considering sociodemographic features, psychopathological state and personality traits. These results could be useful in developing more efficient interventions for GD patients.

The behavior of practicing sports among nursing students

OBJECTIVE

Analyzing the frequency patterns of practicing sports, the stages of change phases and the pros and cons of decision-making balance in nursing students related to gender and which year of study they are in.

METHOD

A cross-sectional, descriptive and exploratory study.

RESULTS

535 students of both genders participated in the study. An analysis of the results revealed that 27.6% of the students did not present any frequency of practicing sports; 55.3% of the students did not have a consistent or continuous habit of practicing sports; students overall exhibited a non-existing frequency of practicing sports at similar levels throughout the study cycle; male students presented similar percentages in their positioning in the precontemplation and contemplation stages throughout the study cycle; and throughout all the stages of change phases students showed higher values for pros over cons related to practicing sports.

CONCLUSION

The results reinforce the relevance for implementing mechanisms for promoting and monitoring nursing students' involvement and regular participation in practicing sports.

Predictors of outcomes of psychological treatments for disordered gambling: A systematic review

This systematic review aimed to synthesise the evidence relating to pre-treatment predictors of gambling outcomes following psychological treatment for disordered gambling across multiple time-points (i.e., post-treatment, short-term, medium-term, and long-term). A systematic search from 1990 to 2016 identified 50 articles, from which 11 socio-demographic, 16 gambling-related, 21 psychological/psychosocial, 12 treatment, and no therapist-related variables, were identified. Male gender and low depression levels were the most consistent predictors of successful treatment outcomes across multiple time-points. Likely predictors of successful treatment outcomes also included older age, lower gambling symptom severity, lower levels of gambling behaviours and alcohol use, and higher treatment session attendance. Significant associations, at a minimum of one time-point, were identified between successful treatment outcomes and being employed, ethnicity, no gambling debt, personality traits and being in the action stage of change. Mixed results were identified for treatment goal, while education, income, preferred gambling activity, problem gambling duration, anxiety, any psychiatric comorbidity, psychological distress, substance use, prior gambling treatment and medication use were not significantly associated with treatment outcomes at any time-point. Further research involving consistent treatment outcome frameworks, examination of treatment and therapist predictor variables, and evaluation of predictors across long-term follow-ups is warranted to advance this developing field of research.

Treatment Outcome in Male Gambling Disorder Patients Associated with Alcohol Use

Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment (post intervention) in male patients with gambling disorder enrolled in a group cognitive behavioral therapy (CBT) program.

Methods: The sample consisted of 111 male individuals with a diagnosis of Gambling Disorder, with a mean age of 45 years (SD = 12.2). All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10–14 patients attending 16 weekly outpatient sessions lasting 90 min each.

Results: The highest mean pre- and post-therapy differences were recorded for the alcohol risk/dependence group on the obsessive/compulsive and anxiety dimensions of the SCL-90-R. As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes.

Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology (measured by the SCL-90-R) were associated with increased risk of alcohol abuse. Alcohol abuse was also associated with poor response to treatment.

A Serious Videogame as an Additional Therapy Tool for Training Emotional Regulation and Impulsivity Control in Severe Gambling Disorder

Background: Gambling disorder (GD) is characterized by a significant lack of self-control and is associated with impulsivity-related personality traits. It is also linked to deficits in emotional regulation and frequently co-occurs with anxiety and depression symptoms. There is also evidence that emotional dysregulation may play a mediatory role between GD and psychopathological symptomatology. Few studies have reported the outcomes of psychological interventions that specifically address these underlying processes.

Objectives: To assess the utility of the Playmancer platform, a serious video game, as an additional therapy tool in a CBT intervention for GD, and to estimate pre-post changes in measures of impulsivity, anger expression and psychopathological symptomatology.

Method: The sample comprised a single group of 16 male treatment-seeking individuals with severe GD diagnosis. Therapy intervention consisted of 16 group weekly CBT sessions and, concurrently, 10 additional weekly sessions of a serious video game. Pre-post treatment scores on South Oaks Gambling Screen (SOGS), Barratt Impulsiveness Scale (BIS-11), I7 Impulsiveness Questionnaire (I7), State-Trait Anger Expression Inventory 2 (STAXI-2), Symptom Checklist-Revised (SCL-90-R), State-Trait Anxiety Inventory (STAI-S-T), and Novelty Seeking from the Temperament and Character Inventory-Revised (TCI-R) were compared.

Results: After the intervention, significant changes were observed in several measures of impulsivity, anger expression and other psychopathological symptoms. Dropout and relapse rates during treatment were similar to those described in the literature for CBT.

Conclusion: Complementing CBT interventions for GD with a specific therapy approach like a serious video game might be helpful in addressing certain underlying factors which are usually difficult to change, including impulsivity and anger expression.

Predictors of Outcome among Pathological Gamblers Receiving Cognitive Behavioral Group Therapy

AIMS

The aim of this study was to evaluate posttreatment changes of individuals with a diagnosis of gambling disorder (GD) treated with group cognitive behavioral therapy (CBT), to assess the potential moderator effect of sex on CBT outcome, and to explore the best predictors of posttreatment changes, relapse, and dropout rates.

METHODS

A cohort design was applied with a prospective follow-up. The sample comprised 440 patients and the CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period.

RESULTS

Patients showed significant improvements in both the level of psychopathology and the severity of the gambling behavior. High self-transcendence and the involvement of the spouse or partner in the therapy predicted a higher risk of relapse. Younger age and low education predicted a higher risk of dropout.

CONCLUSION

Many patients with GD can be treated with strategies to improve self-control and emotional regulation, but other techniques should be incorporated to address the individual characteristics of each patient. This is particularly important in group therapy, in which the same treatment is applied to several patients simultaneously. The involvement of a family member needs to be carefully considered since it may have a negative effect on the response to treatment if not adequately managed.

Gambling in Spain: update on experience, research and policy

AIMS

To describe the current situation of gambling in Spain, sketching its history and discussing the regulations and legislation currently in force within the framework of the European Union (EU), and to review the epidemiology of gambling in Spain, the self-help groups and professional treatments available, and their potential effectiveness.

METHODS

A systematic computerized search was performed in three databases (EMBASE, PubMed and PsychINFO, including articles and chapters) and the reference lists from previous reviews to obtain some of the most relevant studies published up to now on the topic of pathologic gambling in Spain.

RESULTS

Similar to other EU countries, Spain has a high prevalence of pathologic gambling, focused on specific culturally bounded types of gambling. Expenditure in online gaming has risen significantly in the last few years, prompting the Spanish government to draft new legislation to regulate gaming.

CONCLUSIONS

The gaming industry is expected to be one of the fastest growing sectors in Spain in the coming years owing to the rise of new technologies and the development of online gaming.